Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Japan.
Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Japan.
Resuscitation. 2015 Mar;88:63-7. doi: 10.1016/j.resuscitation.2014.12.018. Epub 2014 Dec 31.
The purpose of this study is to determine the outcome of foreign body airway obstruction according to the initial actions taken for choking victims during meals.
Our subjects were patients who became unresponsive or unconscious because of foreign body airway obstruction (FBAO) during meals in the presence of bystander witnesses. We investigated the associations between outcome and the following factors: age, gender, type of foreign body, chest compressions after the patient became unresponsive or unconscious, episode of cardiac arrest, efforts by a bystander to remove the foreign body, eating-related activities of daily living, time elapsed from the 119 call to arrival of emergency medical technicians (EMTs), and time elapsed from the 119 call to hospital arrival (primary endpoint).
Of the 138 patients enrolled during the study period, 35 (25.4%) received chest compressions by bystanders after becoming unresponsive or unconscious and 69 (50.0%) suffered cardiac pulmonary arrest. Chest compressions by a bystander after the victim became unresponsive or unconscious (p<0.0001) and no CPA (p<0.0001) were significantly related to good outcome. Chest compressions by a bystander were both associated with good neurological outcome (odds ratio, 10.57; 95% CI, 2.472-65.059, p<0.0001). No CPA after FBAO was another independent predictor (odds ratio, 50.512; 95% CI, 13.45-284.41; p<0.0001), but efforts to remove the foreign body before the arrival of EMTs did not affect outcome.
Chest compressions by a bystander, a support received by only 25% of the patients, proved to be essential for improved outcome for choking victims who became unresponsive or unconscious. Education for lay-rescuer response to choking might further improve overall outcome.
本研究旨在根据就餐时发生异物气道梗阻（FBAO）的窒息患者的初始急救措施，确定异物气道梗阻的结局。
本研究的对象为在旁观者目击下就餐时因 FBAO 导致意识丧失或无意识的患者。我们调查了以下因素与结局之间的关联：年龄、性别、异物类型、患者意识丧失或无意识后旁观者进行的胸外按压、是否发生心脏骤停、旁观者尝试取出异物、与进食相关的日常生活活动、从拨打 119 到急救人员（EMTs）到达的时间以及从拨打 119 到医院到达的时间（主要终点）。
在研究期间纳入的 138 例患者中，35 例（25.4%）在意识丧失或无意识后接受了旁观者的胸外按压，69 例（50.0%）发生了心肺骤停。意识丧失或无意识后有旁观者进行胸外按压（p<0.0001）和无心脏骤停（p<0.0001）与良好结局显著相关。旁观者进行的胸外按压与良好的神经功能结局相关（优势比，10.57；95%置信区间，2.472-65.059，p<0.0001）。FBAO 后无心脏骤停也是一个独立的预测因素（优势比，50.512；95%置信区间，13.45-284.41；p<0.0001），但 EMTs 到达前尝试取出异物并未影响结局。
仅 25%的患者接受了旁观者的胸外按压，这一支持措施对意识丧失或无意识的窒息患者的结局改善至关重要。对非专业施救者反应噎食的教育可能会进一步提高整体结局。
